Effective January 1, 2014, "health care providers" and "health care facilities" (both defined) are required to make available on request or online the direct pay price for at least the 25 most common services for a provider and at least the 50 most used diagnosis-related group codes and the 50 most used outpatient service codes for a facility, which must be updated at least annually. Does not apply to emergency services. Health care providers who are owners or employees of a legal entity with fewer than three licensed health care providers, veterans administration facilities, health facilities on military bases, Indian health services hospitals and other Indian health service facilities, tribal owned clinics, the Arizona State Hospital and any facility that the Department of Health Services determines does not serve the general public are exempt. Does not prevent a health care provider or facility from offering additional discounts or services to a person or employer paying directly. Government agencies or government-authorized entities are prohibited from approving, disapproving or limiting a health care provider or facility's ability to change the published or posted direct pay price for services. Health care providers or facilities that accept direct payment are deemed paid in full if the entire fee for the service is paid and are prohibited from submitting a claim for payment or reimbursement for that service to any "health care system" (defined). Before a health care provider or facility accepts direct payment, the provider or facility must obtain the person's signature on a notice about direct payment that is substantially similar to a specified form. These requirements self-repeal January 1, 2022. The AHCCCS reimbursement rates for inpatient hospital stays are extended one year to be valid through September 30, 2014. Upon expiration of those rates, the AHCCCS Administration is authorized to adopt a hospital reimbursement methodology consistent with the Social Security Act, and to make additional adjustments to the rates based on specified factors. The AHCCCS Administration is no longer required to obtain legislative approval before adopting the new rates. The AHCCCS Administration is authorized to consider the published diagnosis-related group codes when making adjustments to inpatient hospital reimbursement rates. A legislative intent section states that the Legislature intends for the methodology to be budget neutral in the aggregate. Severability clause. AS SIGNED BY GOVERNOR.

Eliminates the Healthcare Group program effective January 1, 2014. Beginning August 1, 2013, the AHCCCS Administration is prohibited from enrolling new members in the Healthcare Group program. Also removes various transplants and bariatric surgery procedures from the list of services excluded from AHCCCS coverage.

Effective October 1, 2014, the list of medically necessary services that AHCCCS contractors are required to provide is expanded to include an orthotic device utilized for a qualifying condition, if specified conditions are met. Establishes a 7-member Study Committee on Orthotic Device Coverage to research the impact of the loss of and of providing orthotic device coverage on AHCCCS members and the system and to recommend the qualified conditions for orthotic device coverage under AHCCCS that will provide a cost savings to the state. The Committee is required to submit a report to the Governor and the Legislature by October 31, 2013 and self-repeals October 1, 2014. AS PASSED HOUSE.

A 15-member Joint Legislative Study Committee on Electronic Processing and Uniform Prior Authorization for Prescription Drugs is established to develop recommendations reagarding the use of a computer process for the electronic transmission and responses to requests for prior authorization of prescription drug benefits and a uniform prior authorization form for prescription drug benefits. The Committee is required to report its findings and recommendations to the Governor and the Legislature by December 15, 2013. The Committee self-repeals January 1, 2015. AS PASSED HOUSE.

The Director of the Department of Insurance is required to ensure that the state retains its full authority to regulate health insurance policies and contracts, taking into consideration the enactment of the federal Patient Protection and Affordable Care Act (PPACA). Health insurers subject to PPACA are prohibited from issuing a contract or policy or otherwise transacting insurance inconsistent with the applicable provisions of PPACA. Establishes "rating areas" (defined as an area within which a health insurer cannot vary rates based on geography) for the issuance of individual and small group health insurance policies and contracts, with some exceptions. Conditionally repealed as of the date a specified section of the PPACA is declared unconstitutional by the U.S. Supreme Court or is repealed by the U.S. Congress. AS SIGNED BY GOVERNOR.

For each contract year, the AHCCCS Administration and its contractors and subcontractors are required to provide reimbursement for ambulance services for AHCCCS members in an amount equal to 80 percent of the amounts prescribed by the Department of Health Services as of July 1 of each year. The AHCCCS Administration is required to make annual adjustments to the AHCCCS fee schedule according to the Dept's approved ambulance service rate in effect as of July 1 of each year, and the rate adjustments are effective beginning October 1 of each year. Session law requires the AHCCCS Administration and its contractors and subcontractors to reimburse ambulance service providers in an amount equal to 68.59 percent of the Dept's rates for dates of service October 1, 2012 through September 30, 2014, and in amount equal to 74.74 percent of the Dept's rates for dates of service October 1, 2014 through September 30, 2015. Emergency clause. AS PASSED SENATE.

"Health care providers" and "health care facilities" (both defined) would have been required to make available on request or online the direct pay price for at least the 25 most common services for the provider, which would have been updated at least annually. Health care providers who are owners or employees of a legal entity with fewer than three licensed health care providers would have been exempt. Would not have prevented a health care provider or facility from offering additional discounts or services to a person or employer paying directly. Government agencies or government-authorized entities would have been prohibited from approving, disapproving or limiting a health care provider or facility's ability to change the published or posted direct pay price for services. Health care providers or facilities that accept direct payment would have been deemed paid in full and would have been prohibited from submitting a claim for payment or reimbursement for that service to any "health care system" (defined). Before a health care provider or facility accepts direct payment, the provider or facility would have had to obtain the person's signature on a notice about direct payment that is substantially similar to a specified form. Would have self-repealed January 1, 2021. Severability clause. AS VETOED BY GOVERNOR. Her veto message stated that she supports price and quality of care transparency but is concerned about the practical and legal implications of some aspects of the bill.

The Industrial Commission is required to publish a report showing the amount of cash and assets held by the Special Fund that are attributable or allocated to the payment of claims of insolvent insurers as of June 30, 2013. The report must be accompanied by a statement of actuarial opinion by an actuary and must include specified information. The report must be published at the last Commission meeting in 2013. Also specifies that Laws 2013, Chapter 34, which modifies reciprocity for workers' compensation insurance, applies to any claim that has not been accepted as compensable or adjudicated as compensable as of the effective date of that legislation. AS SIGNED BY GOVERNOR.

Health and disability insurance policies or contracts executed or renewed on or after January 1, 2015 are required to provide coverage for health care services for trauma, burn, cardiology, infectious diseases, mental health disorders, neurologic diseases and dermatology that are provided through "telemedicine" (defined as the use of interactive audio, video or other electronic media for diagnosis, consultation or treatment) if the service would be covered were it provided through in-person consultation and if the service is provided to a patient in a "rural region" (defined). Does not apply to limited benefit coverage. AS SIGNED BY GOVERNOR.

The list of actions by an insurer that constitute an unfair practice is expanded to include for a health or disability insurer to apply a higher copayment for a licensed chiropractor, medical doctor or doctor of osteopathy than the insurer requires for a primary care physician if that insurer does not require a referral to that physician from a primary care physician. For determinations of medical necessity for a health care insurer's denial of prior authorization of a chiropractic service requested by a chiropractor, a health care insurer is required, instead of permitted, to use a licensed chiropractor to review the denial. A utilization review agent certificate holder must have a chiropractor available to supervise utilization review activities.

Pursuant to a standing order issued by the chief medical officer of the Department of Health Services or a county health department, or a licensed medical doctor or doctor of osteopathy, a trained school district or charter school employee is authorized to administer or assist in the administration of auto-injectable epinephrine to a student or adult whom the employee believes in good faith to be exhibiting symptoms of anaphylactic shock while at school or at school-sponsored activities. If sufficient monies are appropriated by the Legislature and beginning in the 2014-15 school year, each school district and charter school is required to stock two juvenile and two adult doses of auto-injectable epinephrine at each school. If sufficient monies are not appropriated, a school district or charter school is permitted to stock the epinephrine. Medical personnel and school employees are immune from civil liability with respect to decisions made and actions taken based on good faith implementation of these requirements, except in cases of wanton or wilful neglect. By January 1, 2014, the State Board of Education is required to adopt rules that prescribe annual training for school personnel in the administration of auto-injectable epinephrine, recognition of anaphylactic shock symptoms and procedures for the administration of auto-injectible epinephrine in emergency situations. AS SIGNED BY GOVERNOR.

Makes various policy changes in the areas of public health and welfare that affect the budget. Beginning January 1, 2014, expands eligibility for AHCCCS to include a person whose household's modified adjusted gross income (defined in federal law) is more than 100 percent but equal to or less than 133 percent of the federal poverty guidelines. The AHCCCS Administration is required to discontinue eligibility for these persons if the federal medical assistance percentage is less than 80 percent, or if the maximum amount that can be assessed on health care institutions without causing a reduction in federal financial participation in combination with monies raised from a hospital assessment and other appropriated monies is insufficient to cover those costs. The AHCCCS Director is required to establish, administer and collect an assessment on hospital revenues or bed days for the purpose of funding the nonfederal share of the costs that are incurred for persons eligible for AHCCCS. The Director is required to adopt rules regarding the method for determining the assessment, the amount or rate of the assessment, and modifications or exemptions from the assessment. The assessment is subject to approval by the federal government. Before implementing the assessment, the Director is required to present the methodology to the Joint Legislative Budget Committee. The assessment cannot be collected after the effective date of any reduction of the federal medical assistance percentage to less than 80 percent. Hospitals are prohibited from passing the cost of the assessment on to patients or third-party payors. The AHCCCS Director is authorized to suspend or revoke a hospital's AHCCCS provider agreement registration for noncompliance. If the hospital does not comply within 180 days after suspension or revocation of the provider agreement, the Department of Health Services is authorized to suspend or revoke the hospital's license. Monies collected from the assessment are deposited in the newly established Hospital Assessment Fund and are continuously appropriated. The AHCCCS Director is required to use Fund monies only as necessary to supplement monies in the Prop 204 Protection Account and the Arizona Tobacco Litigation Settlement Fund. The eligibility expansion and the hospital assessment are repealed on January 1, 2017. Appropriates “sufficient monies” from expenditure authority to AHCCCS and the Department of Health Services for the purpose of implementing the expansion. The AHCCCS Administration is required to establish work groups to provide input on the development of the assessment, and to pursue cost sharing requirements for members to the maximum extent allowed under federal law. Establishes a 15-member Medicaid Federal Circuit Breaker Study Committee to research impacts of decreased federal Medicaid funding and submit a report to the Governor and the Legislature by October 1, 2014. By October 1, 2013 and annually thereafter, the AHCCCS Administration is required to report to the Legislature on the change in uncompensated hospital costs experienced by Arizona hospitals during the previous FY. By August 1, 2014 and annually thereafter, the AHCCCS Administration is required to report to the Legislature the amount each hospital contributed for the provider assessment in the previous FY. These reporting requirements self-repeal January 2, 2018. Municipalities are prohibited from levying or imposing an assessment, fee or tax on hospital revenues, discharges, beds or services for the purpose of receiving AHCCCS services or payments. For the contract year beginning October 1, 2013 and ending September 30, 2014, the AHCCCS Administration is authorized to continue the risk contingency rate setting for all managed care organizations and the funding for all managed care organizations administrative funding levels that was imposed for the contract year beginning October 1, 2010. For dates of service on and after October 1, 2013 through September 30, 2014, the AHCCCS Administration and its contractors must reimburse ambulance service providers in an amount equal to 68.59 percent of the amounts prescribed by the Dept. Specifies county contributions for the Arizona Long-Term Care System, and AHCCCS acute care and hospitalization and medical care for FY2013-14. Restores AHCCCS coverage for certain transplants. Disproportionate share payments for FY2013-14 include $89.9 million for a qualifying nonstate operated public hospital in the Maricopa county special health care district, $26.7 million for the Arizona State Hospital and $9.3 million for private qualifying disproportionate share hospitals located in Yuma County with at least 300 beds. Monies in the Long-Term Care System Fund may be used by the Department of Economic Security for operational or programmatic expenses and by the Department of Administration for distribution to counties for operational expenses in FY2013-14. Requires counties to reimburse the Department of Health Services for 50 percent of the costs of a commitment of an individual determined to be sexually violent. Requires municipalities and counties to reimburse the Dept for 100 percent of the costs of a defendant’s inpatient competency restoration treatment. Reimbursements are deposited in the Arizona State Hospital Fund. The Department of Economic Security is authorized to reduce maximum income eligibility levels for child care assistance in order to manage within appropriated and available monies. Requires various reports and audits. Effective January 1, 2014, “health care providers” and “health care facilities” (both defined) are required to make available on request or online the “direct pay price” (defined) for at least the 25 most common services for the provider, which must be updated at least annually. Does not apply to emergency services. Health care services provided by health care providers in veterans administration facilities, health facilities on military bases, Indian health services hospitals and other Indian health service facilities, tribal owned clinics, the Arizona State Hospital and any facility that the Department of Health Services determines does not serve the general public are exempt. Does not prevent a health care provider or facility from offering additional discounts or services to a person or employer paying directly. Government agencies or government-authorized entities are prohibited from approving, disapproving or limiting a health care provider or facility's ability to change the published or posted direct pay price for services. Health care providers or facilities that accept direct payment are deemed paid in full and are prohibited from submitting a claim for payment or reimbursement for that service to any “health care system” (defined). Before a health care provider or facility accepts direct payment, the provider or facility must obtain the person's signature on a notice about direct payment that is substantially similar to a specified form. Direct pay provisions self-repeal January 1, 2022. The list of requirements an applicant must meet to qualify for a license to practice medicine in Arizona is expanded to include that the applicant has submitted to the Arizona Medical Board verification of licensure from every state in which the applicant has ever held a medical license and verification of all hospital affiliations and employment for the five years preceding application. Severability clause. AS PASSED SENATE.